Team Applications Form

Men's Or Women's

Men's Walk

Women's Walk

Title

First name

Last name

Martial Status

Cell Phone

Another Number

Type

Email

Address (Number & Street)

City, State, ZipCode

Occupation

Name of Home Church

Denomination

Church Phone

Church Address

Date & Location of your Walk To Emmaus or CIE Walk #

Do You Require a Special Diet

What Are Your Diet Requirements

Please List Any Medical Conditions

Do You Play A Musical Instrument? If Yes Please List

Are you able to make a commitment of 20+ hours team preparation spread over a 6 to 8 week period?

Information you feel would help in placing you on a team.

Signature (Choose Written or Typed)

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Date

Please send to: Beth Huebert, CIE Registrar, 2464 Atherton Court, Simi Valley, CA 93065. 805-579- 8738. bethhuebert@gmail.com. Teem Fees are $120.00 you can pay with PayPal or give in another method by contacting Beth Hubert

Thank You!